Liberating the NHS

Continuing my look at the White Paper. I’m slowly arriving at similar conclusions to our conference motion (though I disagree with several of the points in that motion; more on that in another post). I’m also looking at this in the context of the BMA response, which also makes sensible suggestions.

Anyway, let’s look at the first section: “Liberating the NHS”.

Our Values

Not much to argue with here. This section makes it plain that the vision is a service that is fair, equal, and free at the point-of-use. It also identifies the following necessary improvements: removal of political interference, additional autonomy, transparency and accountability.

The NHS today

Stripped of the seemingly mandatory praise for the NHS, this section is fairly damning of its performance:

“Compared to other countries, however, the NHS has achieved relatively poor outcomes in some areas. For example, rates of mortality amenable to healthcare, rates of mortality from some respiratory diseases and some cancers, and some measures of stroke have been amongst the worst in the developed world”

“… the NHS has high rates of acute complications of diabetes and avoidable asthma admissions; the incidence of MRSA infection has been worse than the European average; and venous thromboembolism causes 25,000 avoidable deaths each year”

“The NHS also scores relatively poorly on being responsive to the patients it serves. It lacks a genuinely patient-centred approach in which services are designed around individual needs, lifestyles and aspirations. Too often, patients are expected to fit around services, rather than services around patients.”

To me, this section highlights two things. First, the national myth of the NHS, which surrounds it in a rosy glow and isolates it and its staff from criticism, is deeply flawed. Second, the NHS desperately needs reform. By some measures I’ve seen, we’ve underinvested over the last 25 or so years by >£250bn! [Grr, where did I read that? I'll link to the source if I can find it!]

Our vision for the NHS

The callout box is great, highlighting the need for a service that is patient-centric, clinician-driven, with quality and outcome targets, reduced inequalities, better geographic (localised) organisation and sustainability.

I have concerns over the reality of cost-savings from the restructuring proposed. In the past, these have often been illusory, with serious failings in the implementation of well-intentioned reforms. On the plus side, the proposed legislation is radical and the restructuring profound, so cost-savings may well be real.

Improving public health and reforming social care

Another good idea, addressing a deep lack in the NHS: overall public health. It also covers the need to integrate this with social care (it sets out a timetable for reform of social care).

The transfer of local health responsibilities from PCTs to local authorities makes a lot of sense! Public health covers not just primary and social care, but environmental and infrastructure issues (for example: refuse, education, communications, housing, sports facilities, etc) which necessarily belong to local authorities.

The financial position

Not much to say . . . this section reiterates the need for structural reform and cost savings in administration, but sets this against a backdrop of increased (real terms) spending. It also calls for much increased productivity. Let’s wait and see how this translates into reality. Call me cynical.

In summary: the vision outlined here accords well with liberal principles, though as always, the devil will be in the details of the implementation. Next up: “Putting patients and the public first”.